Provider Demographics
NPI:1245500297
Name:JOSAFAT, RICARDO PANGILINAN
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:PANGILINAN
Last Name:JOSAFAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W 168TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5189
Mailing Address - Country:US
Mailing Address - Phone:310-735-7059
Mailing Address - Fax:
Practice Address - Street 1:1029 W 168TH ST APT B
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5189
Practice Address - Country:US
Practice Address - Phone:310-735-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management